Removable Complete and Partial Dentures

dentures

Removable dentures can create a natural and healthy looking set of teeth as well as enhance your smile and sense of self-esteem.

Over time, teeth tend to naturally deteriorate. When a tooth has deteriorated substantially, it often needs to be extracted. When multiple extractions are performed, a removable dental appliance is the least expensive solution for a patient's dental needs.

Dentures replace missing teeth and their adjacent tissues with a removable dental appliance made of acrylic resin and in some cases, a combination of metals. Patients lose teeth for various reasons that may involve severe malnutrition, genetic defects, ineffective oral hygiene or trauma. They are used to provide better chewing abilities, improve the look of a person's smile and help to fill out the appearance of the face and profile. Without the support of these appliances, facial muscles can sag, making a person look older. They can also be made to closely resemble the natural teeth so that little change in appearance will be noticeable.

Removable Complete Dentures are artificial teeth that are designed for patients who have lost all of their real teeth on the upper and/or lower arches of the mouth. Removable Partial Dentures (RPD's) are designed for patients who are missing some teeth on a particular area of the mouth.

Removable Complete Dentures

There are two types of appliances: conventional and immediate.

A conventional appliance is made and placed in the patient's mouth after the remaining teeth are removed and tissues have healed. It is a process that can take several months. An immediate appliance, on the other hand, is inserted as soon as the remaining teeth are removed. With an immediate appliance, the patient does not have to be without teeth during the healing period. An immediate appliance may require basing or relining to fit properly during the healing period (6-8 weeks) due to bone and gum shrinkage. After the healing period, a conventional appliance is then made.

complete dentures

Fabricating a Complete Denture

There are many factors involved when designing this type of appliance and if one factor is overlooked, it can lead to failure of the case. In many instances, the appliance should fit comfortably soon after being inserted. One of the most critical aspects of the process is that the impression must be perfect and with a flawless technique, used to make a model of the patient's gums. The dentist must use a process called border molding to insure that the denture edges do not hit aggressively into the edges of the mouth. An endless array of never-ending problems with this appliance may occur if the final impression is not properly made. Designing it takes a considerable amount of patience.


How a Denture is Made I

The full upper appliance is usually easier to design so that it is stable without slippage. The lower appliance tends to be more difficult because there is no "suction" holding it in place. For this reason, most dentists have come to strongly recommend that a lower denture be supported by 2-4 implants placed in the lower jaw for support. This is a far superior product than a lower appliance without implants that is held in place with weak lower mouth muscles. The ability to bite into an apple or corn-on-the-cob with a lower appliance anchored by implants is possible. The ability to bite into this same apple or corn on the cob with a lower appliance that is not supported with implants, is a difficult, if not impossible task to achieve. Also see the following 20 second video, courtesy of YouTube, what happens when an individual has an unsupported appliance. You certainly do not want this to happen to you during a big moment in your life.

Some patients, believing full denture appliances are in their best interest, extract all of their teeth and have the appliance inserted. Yet, statistics show that the majority of patients who received the appliance in this manner come to regret their decision. They come to find that there is a decrease in their chewing ability (full dentures have only 10% of the chewing power of natural teeth) and they experience difficulty with the appliance sitting properly. They do not realize that while a full upper tends to be very stable, the lower appliance needs as much help from the natural teeth as possible for stability to be successful. If one tooth is retained on the lower area of the mouth, that tooth can contribute to the appliance's stability. It is advised that patients keep their natural teeth as long as possible, especially the lower teeth.


Newly Inserted Dentures

Your new appliance may feel awkward for a few weeks after they are inserted. They may feel loose while the muscles of the cheek and tongue learn to keep them in place. It is also not unusual to experience minor irritation or soreness. You may find that your saliva flow also increases. As the mouth becomes accustomed to the appliance, these problems should diminish. One or more follow-up appointments with the dentist are generally needed after an insertion.

Eating takes practice with a newly inserted appliance. It is advised that patients begin with soft foods cut into small pieces, chewing slowly using both sides of your mouth at the same time to prevent the appliance from tipping. As you become accustomed to chewing, you can add other foods until you return to your normal diet, being very cautious with hot or hard foods and sharp edged bones or shells. Continue to chew food using both sides of the mouth at the same time.

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your appliance "clicks" while you talk, try to speak more slowly. It may occasionally slip when you laugh, cough or smile. Reposition the by gently biting down and swallowing. If any of these problems persist, consult your dentist for further help.

Your dentist will provide instructions about how long the appliance should be kept in place. During the first few days, you may be advised to wear them most of the time, including while you sleep. After the initial adjustment period, you may be instructed to remove them before going to bed. This allows gum tissues to rest and promotes oral health. Generally, the gum tissues should not be constantly covered by the appliance.


Problems with Complete Dentures

Some of the problems associated with removable appliances include an overproduction of saliva, sore spots, gagging, gingivitis and movement.

    Saliva

    The brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. Patients must become accustomed to having an appliance inside their mouth that is not food.

    Sore Spots

    Newly installed appliances may cause sore spots in many individuals as they tend to rub and press on the mucus membranes of the mouth. Subsequent adjustments for the weeks following their insertion should take care of this problem.

    Gagging

    Gagging is another issue encountered by some patients. The cause of this may be due to a loose fitting or to a appliance that is too thick or not extended far enough back on the palate. Some suggest that at times, the gagging may be attributed to some sort of psychological denial of the appliance. And since the psychosis is difficult to treat by the dentist, as it is beyond the scope of their expertise, both a psychologist referral or an implant supported palateless may be offered as alternative to helping a patient.

    Gingivitis

    Gingivitis can develop underneath the appliance, a result of accumulating dental plaque. Gingivitis can involve gum inflammation and mouth sores. The condition is generally reversible. Denture wearers are advised to clean the thoroughly. The removal of plaque and calculus is usually not painful, and the inflammation of the gums should be gone between one and two weeks. A dentist or dental hygienist can also perform a thorough cleaning of the teeth and gums areas of the mouth. Following a professional service, patients must be persistent with their oral hygiene care. Oral hygiene including proper brushing and flossing is required to prevent the recurrence of gingivitis. Anti-bacterial rinses or mouthwash may reduce the swelling and local mouth gels which are usually antiseptic and anaesthetic can also help with the problems associated with gingivitis.

    Movement: Support, Stability and Retention

    Some patients experience problems with keeping their appliances in place. According to Wikipedia sources, there are three rules which dictate the existence of removable oral appliances: support, stability and retention.


    Support

    Support describes how well the underlying oral tissues keeps the appliance from moving. Recently, dentists have been looking to increase the stability of this appliance by using implants. After many years of wearing dentures, the ridges upon which the appliance rests deteriorates and can easily all but disappear. The insertion of implants into the bone below the appliance can help to keep it from occurring. The implants are strategically placed to bear the brunt of the pressure when the appliance is used for chewing, keeping the bone from melting away. When implants are integrated into treatment, the appliance is now referred to as being an implant supported overdenture and the implants are referred to as overdenture abutments.


    Stability

    Stability describes how well the appliance base is prevented from from sliding side to side or front and back. The more the base runs in smooth and continuous contact with the ridge area upon which the teeth used to reside, the better the stability.


    Retention

    Retention describes how well the appliance is prevented from moving in the opposite direction of insertion. The better the inside surface of the base to the surface of the underlying mucus membranes, the better the retention will be. The most critical element in the retentive design of a full upper appliance is a complete and total border seal in order to achieve 'suction'.


Complete Dentures and Implants

There has been an increase in dental practitioners incorporating the use of full dentures with implants. The use of implants when designing a full denture appliance has increasingly shown to improve a patient's denture wearing experience by increasing its stability, as well as saving the patient's bone from wearing away. Implants used with full appliances has also been shown to help with appliance retention.

Removable Complete Dentures Conclusion

How a Denture is Made II

The fabrication of a complete denture appliance is a challenge for any dentist, including those who are experienced. At least two follow up visits for an adjustment to remove sore spots will also be necessary. The upper appliance is fabricated to work in harmony with the lower appliance. If the only variables in the equation are the patient's ridges and two full appliances, the dentist sets the teeth to help prevent dislodgement during opening, closing and swallowing. But once food enters into the picture, the stability of the appliances can be disrupted. During chewing, the appliance bases will sometimes move. In a perfect world, a patient with a perfect edentulous ridge with a perfectly fitting appliance would require no adhesive, as the actual form of the appliance base should work without moving in any way, shape or form. But alas, this is not a perfect world. Therefore, an adhesive is recommended as a way to provide additional retention for well-fitting appliances.

Denture adhesive products should not be used for old, ill-fitting dentures. A poorly fitting appliance can cause constant irritation over a long period of time, and contribute to the development of sores. The appliance may need to be relined or replaced. If, at any point, your dentures begin to feel loose, or cause pronounced discomfort, contact your dentist for a consultation.

Over time, dentures will need to be relined, rebased, or remade due to normal wear. To reline or rebase the appliance, the dentist uses the existing teeth on the denture and refits or makes a new base. The appliances may need to be replaced if they become loose and the teeth show signs of significant wear. This usually occurs as a natural progression of aging. Bone and gum ridges can recede or shrink, causing jaws to align differently. Shrinking ridges causes dentures to fit less securely, making chewing more difficult and changing facial features. Loose appliances can also contribute to sores and infections. Therefore, it is important to replace worn or poorly-fitting appliances before they cause serious health problems.

Removable Partial Dentures (RPD)

removal partial denture partial denture
Example of an RPD
Removable Partial Dentures
There are two types of Removable Partial Dentures (RPD's): fixed and removeable. An alternative to a RPD is a fixed partial denture, better known as permanent bridge. Fixed Partial appliances are designed with abutment crowns and a pontic (false tooth). For the purpose of this article, we will be discussing a removable partial appliance. For more information on a fixed bridge, please use the link above. A new window will open for your convenience.

RPD's are for patients who are missing some teeth in their mouth. They need to have replacement teeth for functional or esthetic reasons, and either cannot afford a fixed bridge or do not meet its criteria.

Note: Another type of RPD is an overdenture. An overdenture is an appliance that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support. Your dentist can determine if an overdenture would be suitable for you.

RPD's usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. They attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments, such as Valplast, are generally more esthetic than metal clasps and they are nearly invisible. Valplast dentures are also very flexible and softer, better conforming to the mouth, making eating a much easier task.

Keep in mind that whichever type of partial you choose, the crowns on your natural teeth may improve the fit of the appliance and are usually required with attachments. And appliances that use precision attachments generally cost more than those with metal clasps. Be certain to discuss your options with your dental provider to find the type that is right for you.

The Different Types of Partials

Partially Edentulous Classifications

Depending on where teeth are missing, RPD's can be grouped under four different classes or partially edentulous arches:

  • Class I (bilateral free ended partially edentulous)
  • Class II (unilateral free ended partially edentulous)
  • Class III (unilateral bounded partially edentulous)
  • Class IV (bilateral bounded anterior partially edentulous)

Components of an RPD

Rather than lying entirely on the edentulous ridge like complete denture appliances, RPD's possess clasps of metal or plastic that "clip" onto the remaining teeth, making the RPD more stable and retentive. The parts of an RPD can be listed as follows:

    Connecting Structures

  • Major Connector - the thick metal "U" in a RPD. In the photo they used a lingual bar.
  • Minor Connector - the small struts protruding from the lingual bar at roughly 90 degree angles.
  • Retaining Structures

  • Direct Retainer - the clasp arms act to hug the teeth and keep the RPD in place.
  • Indirect Retainer - rests for the two canine teeth (as shown in the photo - the one closer to the teeth also has a retentive clasp).
  • Supporting Structures

  • Rests which lay either on the back or front teeth.
  • Base - the pink material, mimicking gingiva.


Flexible Partials

For the first few weeks, your new RPD may feel awkward or bulky, but your mouth will eventually become accustomed to wearing it. Inserting and removing the denture requires practice. Follow all instructions given by your dentist. It should fit into place with relative ease. Never force the RPD into position by biting down as this could bend or break the clasps.

Your dentist should provide specific instructions about how long the RPD should be worn and when it should be removed. Initially, you may be asked to wear the appliance all of the time. Although this may be uncomfortable, it is the quickest way to identify the parts that may need adjusting. If the RPD puts too much pressure on a particular area, that spot will become sore and an adjustment will be needed in order to provide a more comfortable fit. After a while, your dentist may recommend that the RPD be taken out of the mouth at bedtime, and returned to the mouth in the morning.

Wearing a RPD should also improve your speaking ability. If you still find it difficult to pronounce certain words with the new appliance, practice reading aloud. In time, you should become accustomed to speaking properly.

Caring For Your Dentures

Proper care and cleaning will increase the life of your appliance. Although they typically last five years, proper care and minimal jaw recession can extend their life up to 25 years. They should be cleaned daily with a normal or specially made denture toothpaste. In order to prevent them from warping, dentures should be left in water overnight. Over time, the lining may change due to the wear and tear of daily use. When shrinkage occurs with tissue or bone, or the teeth begin to wear down, the denture will need to be remade.
Caring for Your Dentures

    Cleaning Your Mouth

    Even if you have full dentures, you should still follow good oral hygiene. This involves taking good care of your mouth. Like natural teeth, the appliance must be brushed daily to remove food deposits and plaque. Brushing helps to prevent them from becoming permanently stained and helps your mouth to stay healthy. If you have a partial appliance, pay special attention to cleaning teeth that fit under the metal clasps. Plaque can become trapped in this area. Plaque that becomes trapped under the clasps will increase the risk of tooth decay. Your dentist or dental hygienist can demonstrate how to properly brush and clean between teeth.

    Use a brush specially designed for cleaning your appliance. A toothbrush with soft bristles can also be used. Avoid using hard bristled brushes that can cause damage. Each morning, before inserting your appliance, brush the gums, tongue and palate with a soft bristled brush. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth. Make certain to have regular dental checkups. Regular dental check ups are important for examining your mouth and to see if the appliance continues to fit properly.

    Cleaning Your Dentures

    Dentures are very delicate and may break if dropped even a few inches. Stand over a folded towel or a basin of water when handling them.

    To clean the appliances, first rinse away loose food particles, then moisten the brush and apply denture cleanser. Brush every surface, scrubbing gently to avoid damage.

    Some individuals use hand soap or mild dish washing liquid for cleaning the appliance. Avoid using powdered abrasive household cleansers. Your dentist can also recommend a cleanser. Look for denture cleansers with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.

    Your appliance may lose its shape if it is allowed to dry out. When your appliance is not being worn, it should be placed in a cleanser soaking solution or in water. Your dentist can recommend the best method for you to use. Never place the appliance in hot water, which could cause them to warp.

    Ultrasonic cleaners can also be used to clean these appliances.

Dentist Emergency

You can seriously damage your dentures and harm your health when attempting to adjust or repair it. Attempting to do so, can cause greater damage to the appliance and in your mouth. See your dentist if your appliance breaks, cracks, chips, or if one of the teeth becomes loose. A dentist can often make the necessary adjustments or repairs on the same day. Complicated repairs may require that the appliance be sent to a dental laboratory. The use of any type of over the counter type glue product is not recommended for use on these appliances. These products often contain harmful chemicals and can cause further damage to the appliance. So, please let the dentist do any repairs that may be needed.








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